5. Marco teórico referencial
6.3. Referentes teóricos
6.3.2. Directrices para el diseño, desarrollo y evaluación de recursos educativos
Intervention Description Background
Multidimensional Treatment Foster Care (MTFC) was developed in the early 1980s by Patricia Chamberlain, Ph.D., and colleagues at the Oregon Social Learning Center to address serious and violent juvenile offenders who would otherwise need to be placed in a group or residential program. Thirteen years later, Philip Fisher, Ph.D., and colleagues developed the MTFC program for preschoolers (MTFC-P). This intervention is similar to the earlier developed MFTC but is tailored to meet the developmental needs of preschoolers who display early aggressive and acting-out behavior and can benefit from intensive treatment in the home and community.
MFTC has been disseminated in many states and countries, such as Great Britain, Sweden, and the Netherlands. Within the last 2 years, more than 65 organizations have implemented MTFC (P. Chamberlain, personal communication, June 6, 2007).
Characteristics of the intervention
MTFC is delivered by trained treatment families to provide intensive supervision and support to children and adolescents at home, in the community, and at school. MTFC and MTFC-P children considered eligible for services are those who are at risk of being placed or are currently placed outside the home in the child welfare, mental health, or juvenile justice systems. Therefore, many of the children referred to MTFC and MTFC-P come from one of these agencies.
Figure 18
Multidimensional Treatment Foster Care Type of EBP Intervention
Setting Clinic Home School Age 3–18 Gender Males Females Training/Materials Available Yes
Outcomes
Decrease in arrest rates. Decrease in violent activity involvement.
Fewer runaways.
Less chance of incarceration after completing program. Fewer permanent replacement failures (MTFC-P).
Treatment families are recruited and screened before youth are placed in their homes. Formal training, ongoing supervision, and weekly meetings with parents are held to help families address problems and to note youth progress. A trained case manager connects daily with the treatment family and is also available to the child’s biological family. In both MTFC and MTFC-P, the goal is for the youth to continue to sustain contact with his or her biological family and for that family to get services while the child is in placement so that they are better prepared when the child returns home. Youth participate in skill-enhancing therapy. Treatment families maintain close contact with the schools about their child’s behavior and progress in the school environment. If the youth is involved with a probation system or other youth system, the case manager helps the youth and treatment family maintain contact.
Research Base and Outcomes
MTFC has been researched extensively since 1990. The research base includes randomized control trials examining the effect of the
intervention over control groups (retrieved from
http://www.mtfc.com/program_effectiveness.html). Across studies, evidence supports the intervention. Specifically, the research on adolescents has
found that youth in MFTC have fewer runaway incidences and are arrested less often than youth in group care. Research supports that MTFC youth have significantly fewer days in locked settings (detention, training schools, hospitals, etc.) at followup. (http://www.mtfc.com). For preschool
children, those in MTFC-P had fewer placement disruptions in followup. Further information about MFTC studies is presented in Table 18.
Table 18: Multidimensional Treatment Foster Care: Research Base and Outcomes
Reference Research Design and Sample* Outcomes
Chamberlain (1990) Youth committed to state training schools (n = 32, ages 12–18), matched comparison design on age, sex, and date of commitment. Youth selected for either Treatment Foster Care (TFC) group or another community based treatment.
Followup period of 2 years. Study population: Male 62.5% Female 37.5%
TFC participants spent fewer days incarcerated.
Chamberlain & Reid (1991)
Randomized control trial design with youth from Oregon State Hospital, (n = 20, ages 9–18) assigned to either TFC or typical community treatment. Followup period of 7 months.
Study population: Male 60% Female 40%
TFC placed out of hospital at higher rate; more TFC were placed in family homes.
Chamberlain, Moreland & Reid (1992)
Randomized control trial design with foster care families (n = 70) assigned to assessment only group (AO), increased payment only group (IP), or enhanced training and support (ETS) with TFC methods.
Followup period of 7 months. Study population: Male 60% Female 40% 86% White 6% African American 4% Hispanic
4% American Indian, Asian American, Mixed
ETS group had greater foster parent retention and fewer disruptions in placement than AO or IP group.
Chamberlain & Reid (1997)
Randomized control trial of male juvenile offenders (n = 79, 12–17 years, mean offenses = 13), assigned to MTFC or group care for 1-year period. Study population:
100% male
At follow up, MTFC group had half as many arrests, fewer days incarcerated, and higher rates of program completion.
Table 18: Multidimensional Treatment Foster Care: Research Base and Outcomes
Reference Research Design and Sample* Outcomes
Eddy, Bridges, & Chamberlain (2004)
Randomized control trials, youth (n = 79), assigned to either MTFC group or service as usual/ group care.
Data collected every 6 months for 2 years. Study population: 100% male 85% White 6% African American 6% Hispanic 3% American Indian
MTFC youth were significantly less likely to commit violent offenses; 5% of MTFC youth had two or more criminal referrals for violent offenses at 2 years compared to 24% of the control group.
Fisher, Burraston, & Pears (2005)
Randomized control trial of children (n = 90, ages 3–6) assigned to foster care placement or MTFC-P placement.
Study population: Male 63% Female 37% 85% White 11% Hispanic 4% American Indian
Children in the MTFC-P program experienced fewer permanent placement failures.
Leve, Chamberlain, & Reid (2005)
Randomized control trial of girls with chronic delinquency (n = 81, ages z13–17) assigned to either MTFC or group care (GC). Study population: Female 100% 74% White 12% American Indian 9% Hispanic 2% African American 1% Asian American 2% Other or Mixed Ethnicity
MTFC youth had a greater reduction in the number of days spent in locked settings and in caregiver- reported delinquency.
MTFC group has 42% fewer criminal referrals than GC youth at 12-month followup.
Chamberlain (1990) Youth committed to state training schools (n = 32, ages 12–18), matched comparison design on age, sex, and date of commitment. Youth selected for either Treatment Foster Care (TFC) group or another community based treatment.
Followup period of 2 years. Study population: Male 62.5% Female 37.5%
TFC participants spent fewer days incarcerated.
Implementation and Dissemination Infrastructure issues
Readiness:
The formal readiness process involves a conversation, a self-evaluation form, and, if needed, a site visit. A discussion is held with the site to determine whether it is advantageous to bring this program to their site.
A readiness checklist is used as a resource. Before sending the checklist, an initial conversation is held and a packet of information is sent. After receipt and completion of the readiness checklist by the site, the Oregon team reviews the checklist and further discusses the process.
Staffing:
Criteria are available for MTFC and MTFC-P sites that outline the staff best suited to implement the program.
Possible barriers:
Challenges for both MTFC and MTFC-P include funding, the need for solid organizational structure with key champions helping to drive and sustain implementation efforts, and the need for practitioner commitment to the model.
Training/coaching and materials
TFC Consultants, Inc. disseminates MTFC (http://www.mtfc.com).
Four trainings are offered per year in Eugene, Oregon. Each site sends a team of key
professionals, including a supervisor, to attend the training. The training for program supervisors lasts approximately 5 days. The remaining key professionals attend 4 days of training. The training uses didactic and role- playing instruction methods. In addition, the attendees also observe a foster parent meeting with a supervisor.
Upon completion of the staff training, the MTFC or MTFC-P program is ready for implementation. Members of the Oregon team come to the site to conduct the first foster parent meeting with site staff observing. After this meeting, telephone calls with the site consultant and review of videotaped foster parent and clinical meetings are conducted.
Up to 6 days of onsite consultation are available to sites throughout the startup and implementation.
Typically, sites will be fully operational after a full year.
Sites can become MTFC or MTFC-P certified after successfully graduating seven youth. The criterion-based certification requirements are available on the MTFC Web site. A self- evaluation tool is available, but the certification review is conducted by a research group not connected with the program’s disseminating group, TFC Consultants. Initial certification lasts 1 year; recertification can last up to 2 years. TFC Consultants are available to offer support to those sites that are not ready for certification.
For information on training and materials, contact:
TFC Consultants, Inc. Gerard Bouwman, President
Telephone: (541) 343-2388 ext. 204 Cell phone: (541) 954-7431
Fax: 541-343-2764 [email protected]
Center for Research to Practice Rebecca Fetrow
Program Evaluation Telephone: (541) 343-3793 [email protected]
Cost of training/consulting
There is no cost for the readiness process, unless a site visit is required.
The cost to implement either MTFC or MTFC-P is $40,000 to $50,000. Developer involvement
MTFC: The developer, Dr. Patricia Chamberlain, is still involved in disseminating the program.
MTFC-P: The developer, Philip Fisher, PhD, is currently involved in disseminating the preschool program.
Monitoring fidelity and outcomes
Fidelity measures exist for both MTFC and MTFC-P. TFC Consultants collect fidelity data from sites.
The reporting of outcomes is required when implementing MTFC and MTFC-P to obtain certification.
Financing the intervention
Many sites apply for grant dollars and use funds from child welfare, early childhood special education funds, and county mental health funds to finance the MTFC or MTFC-P intervention. Sites with an older youth population have used juvenile justice funding.
The treatment foster care element of the intervention may be covered by Medicaid.
Resources/Links http://www.mtfc.com
References
Chamberlain, P. (personal communication, June 6, 2007).
Chamberlain, P. (1990). Comparative evaluation of specialized foster care for seriously delinquent youths: A first step. Community Alternatives: International Journal of Family Care, 2(2), 21–36. Chamberlain, P. (2002). Treatment foster care.
In Burns, B., & Hoagwood, K. (Eds.)
Community Treatment for Youth: Evidence- based interventions for severe emotional and behavioral disorders (pp. 117–138). Oxford University Press: New York.
Chamberlain, P., & Mihalic, S. F. (1998).
Multidimensional Treatment Foster Care: Blueprints for Violence Prevention, Book Eight. Blueprints for Violence Prevention Series (D.S. Elliott, Series Editor). Boulder, CO: Center for the Study and Prevention of Violence, Institute of Behavioral Science, University of Colorado.
Chamberlain, P., Moreland, S., & Reid, K. (1992). Enhanced services and stipends for foster parents: Effects on retention rates and outcomes for children. Child Welfare, 71(5), 387–401. Chamberlain, P., & Reid, J. B. (1991). Using a specialized foster care community treatment model for children and adolescents leaving the state mental health hospital. Journal of Community Psychology, 19, 266–276.
Chamberlain, P., & Reid, J. B.(1998). Comparison of two community alternatives to incarceration for chronic juvenile offenders. Journal of Consulting & Clinical Psychology, 66(4), 624–634.
Eddy, J., Whaley, B., & Chamberlin. P. (2004). The prevention of violent behavior by chronic and serious male juvenile offenders: A 2-year follow up of a randomized clinical trial. Journal of Emotional and Behavioral Disorders, 12(1), 2–8. Leve, L., & Chamberlain, P. (2005). Intervention
outcomes for girls referred from juvenile justice: Effects on delinquency. Journal of Consulting and Clinical Psychology, 73 (6), 1181–1185. Fisher, P., Burraston, B., & Pears, K. (2005).
The early intervention foster care program: Permanent placement outcomes from a randomized trial. Child Maltreatment, 10(1), 61–71.
Smith, D.K. (2004). Risk, reinforcement, retention in treatment, and reoffending for boys and girls in Multidimensional Treatment Foster Care.
Journal of Emotional and Behavioral Disorders, 12(1), 38–48.
*Extensive reference list is available from
Evidence-Based
and Promising Practices
Acknowledgments
The development of the Guide was funded by the Child, Adolescent and Family Branch of the SAMHSA Center for Mental Health Services. The Guide was developed by a team composed of:
Barbara J. Burns, Ph.D.
Duke University School of Medicine
Sylvia K. Fisher, Ph.D.
SAMHSA/CMHS
Vijay Ganju, Ph.D.
Abt Associates
G. Michael Lane, Jr., M.A., M.P.H.
NASMHPD Research Institute, Inc.
Mary Beth Nazzaro, M.A.
NASMHPD Research Institute, Inc.
Jeanne C. Rivard, Ph.D.
NASMHPD Research Institute, Inc.
Kristin Roberts, B.B.A.
Acknowledgments
The development team would like to extend our deepest appreciation to the scores of individuals who contributed their valuable time in reviewing, editing, and providing feedback to enhance the usefulness of this Guide to the field. In particular, we would like to thank:
The Children’s Mental Health Implementation Resource Kit Expert Consensus Panel who guided our initial planning efforts and provided critical feedback in the early stages of
development. The panel was composed of: Uma Ahluwalia, Ph.D.; Karen Blase, Ph.D.; Rachele Espiritu, Ph.D.; Tina Donkervoet; Luz Garay; Darcy Gruttadaro, J.D.; Mary Hargrave, Ph.D.; Mareasa Isaacs, Ph.D.; Teresa Kramer, Ph.D.; Gary MacBeth, MSW, M.Ed.; Danna Mauch, Ph.D.; Mary McBride, Ph.D.; Kenneth Rogers, M.D.; Ben Saunders, Ph.D.; Jackie Shipp; Luanne Southern, M.S.W.; Sandra Spencer; Mark Weist, Ph.D.
Kenneth Rogers, M.D. who developed the section on medication management.
Mary Tierney, M.D. who helped us to develop the financing section with information about Medicaid programs.
Karen Blase and Sandra Naoom of the National Implementation Research Network (NIRN) who contributed tremendously by interviewing the intervention developers for details related to implementing the evidence-based practices covered in the Guide.
The Evidence-based Practices Subcommittee of the Outcomes Roundtable for Children and Families who assisted us in reviewing the research base of interventions as they pertained to culturally and ethnically diverse groups and who urged us to develop a supplement to the Guide with brief information for families about each of the intervention and prevention EBPs.
Darcy Gruttadaro, J.D. of the Children’s Division of the National Alliance on Mental Illness (NAMI) and Sandra Spencer of the Federation of Families on Children’s Mental Health (FFCMH) who provided us with guidance and feedback in developing the brief supplement for families.
Twenty-three independent reviewers consisting of family members, practitioners,
administrators, and evaluators from agencies across the nation.